Abdominoplasty ("tummy tuck")

What is Abdominoplasty? Is it right for me?

Abdominoplasty (also known as a “tummy tuck”) is a common operation. It removes an excess of soft tissue that may be left over following weight loss or pregnancy; this tissue has usually been stretched and will not respond to further weight loss or exercises. The excess soft tissue causes a fold of skin and loose fat, usually in the mid to lower third of the abdomen, and may be associated with underlying abdominal wall weakness, especially after pregnancy.

A tummy tuck removes the excess tissue and tightens the abdominal wall leaving your abdomen flatter and firmer.

You may consider an abdominoplasty, if the excess soft tissue is causing you one or more of these problems:

• Sweating, rashes and skin infections under the fold of excess skin
• Difficulty participating in sports or swimming
• Self-consciousness and psychological distress because of the appearance of your abdomen
• Unwelcome and inappropriate comments from others
• Weakness of the abdominal wall muscles (recti muscles), which creates a bulge when straining, or lifting. This problem is particularly common after pregnancy.

If you are considering a tummy tuck, the first step will be an initial consultation. During this first meeting, we will be able to discuss your individual situation, concerns and possible treatment options. And very importantly, we will be able to get to know each other; the decision to have an abdominoplasty is intensely personal, requiring a great deal of thought and mutual trust.

 

Preparing for your Abdominoplasty

For the best results of a tummy tuck, it is optimal if you have a body mass index (BMI) as close to normal (25) as possible, and be smoke free. If you have given up smoking recently, I advise you not to use nicotine replacement therapy for four weeks before your operation and four weeks after, as nicotine can significantly affect your body’s healing abilities.

For women, I recommend that your family is complete before having your tummy tuck.

And the same is true if you are planning to lose more weight: it is best to postpone your abdominoplasty until after you have reached your goal weight.

 

About your surgery, hospital stay and recovery phase

When we have decided together that you will have an abdominoplasty, it is time to get ready for the surgery, your hospital stay, and the recovery time that follows. Here’s what the operation involves, what I would like you to bring to hospital, and what your body will feel like throughout your recovery.

 

What does an abdominoplasty involve?

A tummy tuck needs a general anaesthetic. During the surgery, I make a large horizontal incision from one side of your hips to the other, just above the pubic hair-line. The tummy wall is lifted up beyond the tummy button, almost up to your rib cage. Meanwhile, the tummy button is kept attached to the underlying muscle by a stalk of tissue that maintains its blood supply. Your tummy muscles are tightened if that is required. Then I remove your excess skin and fat. The tummy button is then reinserted through a new hole in the tummy wall. Finally, the skin is re-draped and sutured over drains. All sutures are dissolving and won’t have to be removed later. A supportive garment is provided after the operation.

The operation takes about two to three hours.

 

What should I bring to hospital?

It is important that you bring a few suitable support knickers with you. Essentially, these are “shaper-knickers” and need to go right the way up to under your bust. You will go into these a day or so after your operation.

I like you to have some Micropore^TM tape available for after the operation. Your local pharmacy should have the Micropore or something similar available to buy.

 

Your hospital stay after the surgery

People are often very worried about pain after surgery and myself and your anaesthetist will do our very best to make sure you are as comfortable as possible. To start with you may have pain relief into your ‘drip’ (directly into your vein) and later we change that to oral pain relief. I also put lots of local anaesthetic around the wound during the operation to help with your post-operative comfort.

Right after the operation, you will be unable to straighten fully and will be nursed in a ‘deck-chair’ position, with pillows under your knees. Over the coming days, you will gradually be able to stand and walk normally again. Don’t rush this, as it is a function of your tummy being nice and flat again.

Once you are in your hospital room, a small injection will be given into your tummy to reduce the risk of blood clots developing in your legs or lungs (DVT, PE).

You will have a catheter (a little tube that goes up into your bladder through the urethra) to drain urine. This means you don’t have to get up to go to the toilet over the first few days.

After 48 hours, it’s usually okay for you to have a brief shower. It is fine for fresh water, soap and shampoo to run over the wounds. Please avoid bathing in a bath or swimming pool until the wounds are completely healed. After your shower, dry the tapes carefully by leaving them open to the air or by using a hairdryer on cool (a hairdryer on warm or hot may burn the wounds!). The tapes can stay on for 7-14 days, however if they become loose, tatty or moist then the tape may be changed earlier.

It is possible that you will leave hospital with one or two drains in place. In that case, district nurses will visit you at home and remove the drains at the appropriate time.

 

After leaving the hospital

You will be in hospital for 3-4 nights. Following that, please plan to have someone help you at home with shopping, housework and childcare for perhaps 2 weeks following the operation. It will be at least 6 – 8 weeks before you feel back to your usual self, and you will need to take things easy during this time so your body can heal.

It is best not to drive for at least 2-3 weeks following the operation. You can start driving again when it is comfortable to wear a seat belt and you feel confident and comfortable to control a car.

Please wear good supportive undergarments all the time (23 of 24 hours a day) for the first 3 months. This will help you achieve the best possible long-term results of your tummy tuck.

Avoid strenuous activity for at least 6 weeks; be guided by how you feel and be sensible. Please wait 12 weeks before beginning abdominal exercises such as crunches and gym weights.

I will see you the week following your operation and then usually at the six-week mark. However sometimes it is necessary to see people on a weekly basis while the wounds are healing. If you have any concerns I want you to feel free to contact me anytime to clarify things or address worries.

 

How can I improve my scars from the abdominoplasty?

Keeping the scars taped for 6 weeks is important. After that, you can massage your scars twice daily with a plain, unscented, hypoallergenic moisturising cream. It is very important to avoid any UV exposure for 24 months following the operation. UV exposure can cause scars to pigment strongly. Your scars should fade and flatten over 12 months.

Starting six weeks after the surgery, I will ask you to moisturise the scars. You can use a plain, hypoallergenic, unscented moisturiser from your pharmacy. I don’t recommend a particular brand. For best results, it is most important to moisturise and massage the scars regularly.

To start with, the scars are fairly thin and it is usual for scars to thicken and become red as they heal. If your scars become very red, itchy or thick, please contact me as you could be developing hypertrophic or keloid scarring that may need special silicone dressings or steroid injections.

 

What are the possible complications of a tummy tuck?

Pain

Pain is usually not severe and you can manage it by oral pain relief. It is often worse when you move around and cough. This pain settles with time.

Infection

Wound infection can occur after any surgical procedure. You are given a dose of antibiotics at the beginning of the operation. Further antibiotics are not routinely given, because this leads to antibiotic resistance. The signs of infection are increased redness, discharge from the wound, fevers or feeling unwell (similar to getting the ‘flu’). If your wound gets infected, more antibiotics will be required, and sometimes admission to hospital or an operation may be needed to resolve it.

Bleeding

Bleeding can be minor at best, or, in the worst case, it can lead to a collection of blood (a haematoma) that needs to be drained in theatre. This is likely to be a concern in the first few days after surgery.

Wound healing problems

Sometimes the wounds take a longer time to heal and may require dressings for some weeks. This is more likely to happen if you smoke or are overweight. Occaionally, District Nurses will need to come to your house for dressings for a few weeks after the procedure.

Scars

You will have a long permanent scar following the operation. Hopefully the scar will be fine and pale, but some people have a tendency to poor scarring and their scars can be thickened, itchy and unsightly (hypertrophic or keloid scarring). Occasionally, I will recommend revision surgery for scars.

Scar Asymmetry

Your scar may be slightly asymmetrical although I will try and make it as perfect as possible. Sometimes there is a bit of fullness at the ends of the scars; this should settle and flatten with time. Occasionally, the scar will need another small operation to improve it.

Recurrence

If I correct the divarication of your recti (separated tummy muscles) during the operation, there is a chance that this could recur with time.

Numbness

Your tummy will feel numb following the operation and this tends to be permanent.

Seroma

A seroma is tissue fluid accumulating within the tummy wound. The drains I put in place during the surgery take care of this initially. But if the fluid recurs, usually as swelling of the tummy, then it may need to be drained away using a little needle. I would do this for you during one of our follow-up visits after the operation.

Clots in the legs or lungs

There is small risk of this with any large operation, and especially one involving the abdomen. To prevent this, you will wear special stockings and have an injection of a blood thinner medication into your tummy each night. You will have a little machine to massage your legs for the first few days. For women, it is best to stop oral contraceptive pills for 6 weeks before surgery and use alternative forms of contraception.

Loss of the belly button

This is a very rare complication and occurs due to reduced blood supply to the belly button. It is treated with dressings and rarely may require another operation to re-create a belly button.

The future

An abdominoplasty will not prevent you from gaining weight in the future.
Your scars will settle and swelling will resolve over time and it may be 12 months before you have your final result.